Combined predictive value of prognostic nutritional index and neutrophil to lymphocyte ratio for all-cause mortality risk in maintenance hemodialysis patients: a cohort study followed for 5 years.

Background: To assess the prognostic value of the prognostic nutritional index (PNI) alongside the neutrophil-to-lymphocyte ratio (NLR) in forecasting all-cause mortality in patients undergoing maintenance hemodialysis (MHD), and to pinpoint independent risk factors linked to all-cause mortality, thereby facilitating the guidance of prompt clinical interventions.

Methods: A retrospective cohort investigation was carried out with the gathering of comprehensive demographic and clinical biochemical information. The follow-up period ended in December 2024, with all-cause mortality serving as the primary outcome measure. The predictive capabilities of PNI and NLR regarding all-cause mortality in MHD patients were evaluated through receiver operating characteristic (ROC) curve analysis. In addition to the plotting of Kaplan-Meier curves, the Cox model was utilized to pinpoint risk factors affecting 5-year all-cause mortality in MHD patients.

Results: A sum of 632 patients receiving MHD was analyzed during the follow-up. The area under the curve (AUC) for PNI and NLR was 0.739 and 0.668, with an optimal cutoff value of 43.094 and 2.937, respectively. Furthermore, patients presenting a PNI of ≥ 43.094 showed a better cumulative survival rate throughout the follow-up when compared to those with a PNI of < 43.094 (χ² = 56.461, P < 0.001). In contrast, patients with an NLR of ≥ 2.937 exhibited a diminished cumulative survival rate as opposed to those with an NLR under 2.937 (χ² = 125.414, P < 0.001). The Cox regression model identified male sex, utilization of central venous catheters (CVCs), an NLR of ≥ 2.937, increased absolute neutrophil count, and elevated aspartate aminotransferase (AST) levels for predicting 5-year all-cause mortality independently (P < 0.05). Conversely, a PNI of ≥ 43.094, along with high levels of hemoglobin, urea, and uric acid, were recognized as protective factors (P < 0.05).

Conclusion: Both PNI and NLR have significant predictive value concerning all-cause mortality in MHD patients.

Clinical Trial Number: Not applicable.